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Ann Neurol-哈佛大学发现:脑震荡,会导致脑血管调节机制改变

2021-07-05 Freeman MedSci原创

Ann Neurol-哈佛大学发现:脑震荡,会导致脑血管调节机制改变

在每年发生的近20万起脑震荡中,年龄在10-19岁的人发病率最高。这种年轻时的高发病率令人担忧,因为其潜在的后遗症超出了初级症状的范围。然而,人们对脑震荡症状的急性病理生理学知之甚少,主要来自动物模型。

在青少年和年轻成年人中,与运动相关的脑震荡,标准的神经影像学很少能够识别神经损伤的迹象,只有1.5-3%的CT和MRI在受伤后30天内显示出神经损伤的迹象。虽然高级神经影像学显示脑震荡后神经完整性和功能连接有一些改变,但有脑震荡史的无症状年轻成年运动员也有类似改变的报道6,而且与自我报告的症状相关性很差。因此,急性和亚急性症状负担似乎并不是由严重的结构性神经损伤造成的。另外,支持神经功能的生理机制的破坏可能是脑震荡后症状的来源。

脑震荡后,最佳的脑血流是必要的,以满足受伤大脑增加的代谢需求。然而,来自动物和人类的数据表明,脑震荡后脑血流可能会减少,并可能在很长一段时间内保持减少,导致 "能量错配",或神经代谢危机。虽然这似乎是合理的,但现有的数据是相互矛盾的:遭受脑震荡的人的整体和区域脑血流可以减少、不变,甚至增加,这些变化可能与症状负担有关,也可能无关。虽然这种差异的部分原因可能是由于研究方法的不同,但它也强调了脑震荡影响脑血流的调节以满足代谢需求的可能性,而不是静止血流本身。

在健康人中,脑血管通过缓冲动脉二氧化碳的变化(即通过血管活性)和动脉压力的变化(即通过自动调节)的能力来调节脑血流量。 之前数据都显示,在有持续脑震荡后症状的成年人中存在脑血管功能紊乱。然而,脑震荡后急性期是否存在类似的脑血管功能改变,这些改变是否反映在脑血流中和/或与症状负担有关,以及这些改变是否持续到急性期和症状明显缓解之后,仍然是未知数。

藉此,哈佛大学的Stacey E. Aaron等人,对此开展研究。

根据大脑中动脉血流速度,他们对28名脑震荡参与者(受伤后≤14天)和29名匹配的对照组进行了大脑血管活性和自动调节的评估。脑震荡组的参与者返回进行为期8周的后续评估。在这8周的时间里,参与者记录了有氧运动的频率和时间。

他们发现。各组之间,人口统计学、临床和血液动力学变量没有明显的不同。

脑震荡组的血管活性明显更高(P = 0.02)。在脑震荡组内,静止脑血流速度的60%的变化是由血管反应性和自动调节的两个组成部分--下降斜率和自动调节的有效性解释的(调整后的R2=0.60,P<0.001)。

此外,较低的平均动脉压、对动脉压上升的较低反应和较低的血管活性与较大的症状负担明显相关(调整后的R2 = 0.72,p < 0.01)。

到了8周的时间点,除了4名脑震荡参与者外,所有其他参与者的症状负担都得到了改善,但血管反应性没有改善(P < 0.01)。血管反应性的8周变化与有氧运动量呈正相关(调整后的R2=0.19,P=0.02)。

这个研究的重要意义在于:脑震荡导致了脑血管调节机制的改变,这反过来又解释了静止脑血流速度和急性症状负担的变化。此外,尽管症状得到缓解,这些改变仍长期存在,但被有氧运动量积极地改变。这些发现为进一步研究脑血管相关症状提供了一个机制框架。


原文出处:Aaron SE, Hamner JW, Ozturk ED, Hunt DL, Iaccarino MA, Meehan WP 3rd, Howell DR, Tan CO. Cerebrovascular Neuroprotection after Acute Concussion in Adolescents. Ann Neurol. 2021 Jul;90(1):43-51. doi: 10.1002/ana.26082. Epub 2021 Apr 28. PMID: 33855730.

 
 
 
 

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    2021-12-04 yinhl1978
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    2021-07-06 amyloid
  5. [GetPortalCommentsPageByObjectIdResponse(id=2001390, encodeId=14162001390d9, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Sat Dec 04 01:50:56 CST 2021, time=2021-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1910927, encodeId=3a53191092e82, content=<a href='/topic/show?id=04d99206316' target=_blank style='color:#2F92EE;'>#调节机制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92063, encryptionId=04d99206316, topicName=调节机制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf1b289, createdName=villahu, createdTime=Thu Sep 30 01:50:56 CST 2021, time=2021-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316274, encodeId=809b13162e410, content=<a href='/topic/show?id=654a85168c0' target=_blank style='color:#2F92EE;'>#脑震荡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85168, encryptionId=654a85168c0, topicName=脑震荡)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0041445, createdName=TZF0804, createdTime=Tue Jul 06 19:50:56 CST 2021, time=2021-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1557529, encodeId=49a7155e52923, content=<a href='/topic/show?id=7bec398e2e6' target=_blank style='color:#2F92EE;'>#哈佛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39872, encryptionId=7bec398e2e6, topicName=哈佛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c7014916331, createdName=amyloid, createdTime=Tue Jul 06 19:50:56 CST 2021, time=2021-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=996326, encodeId=daae996326c1, content=学习中, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210704/cdd1076905df433c93873ae6d3d51aef/eae5c73864694494acb8435eb7d2e9bb.jpg, createdBy=ec7b92572, createdName=lshanp, createdTime=Mon Jul 05 09:06:58 CST 2021, time=2021-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=996321, encodeId=e943996321e2, content=???, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210703/9c448fe1b3b54fd7bc9477662f4861bb/4bdadad22bfd46f2921aabb4c40265d3.jpg, createdBy=a8d81938466, createdName=weigq, createdTime=Mon Jul 05 08:38:39 CST 2021, time=2021-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1039434, encodeId=6fd61039434cf, content=机制研究离临床仍然有距离,不过与临床结合思考,仍然有帮助的,不能仅仅是纯临床思维,转化思维同样重要, beContent=null, objectType=article, channel=null, level=null, likeNumber=133, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿肿, createdTime=Mon Jul 05 07:50:56 CST 2021, time=2021-07-05, status=1, ipAttribution=)]
    2021-07-05 lshanp

    学习中

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2001390, encodeId=14162001390d9, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Sat Dec 04 01:50:56 CST 2021, time=2021-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1910927, encodeId=3a53191092e82, content=<a href='/topic/show?id=04d99206316' target=_blank style='color:#2F92EE;'>#调节机制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92063, encryptionId=04d99206316, topicName=调节机制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf1b289, createdName=villahu, createdTime=Thu Sep 30 01:50:56 CST 2021, time=2021-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316274, encodeId=809b13162e410, content=<a href='/topic/show?id=654a85168c0' target=_blank style='color:#2F92EE;'>#脑震荡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85168, encryptionId=654a85168c0, topicName=脑震荡)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0041445, createdName=TZF0804, createdTime=Tue Jul 06 19:50:56 CST 2021, time=2021-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1557529, encodeId=49a7155e52923, content=<a href='/topic/show?id=7bec398e2e6' target=_blank style='color:#2F92EE;'>#哈佛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39872, encryptionId=7bec398e2e6, topicName=哈佛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c7014916331, createdName=amyloid, createdTime=Tue Jul 06 19:50:56 CST 2021, time=2021-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=996326, encodeId=daae996326c1, content=学习中, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210704/cdd1076905df433c93873ae6d3d51aef/eae5c73864694494acb8435eb7d2e9bb.jpg, createdBy=ec7b92572, createdName=lshanp, createdTime=Mon Jul 05 09:06:58 CST 2021, time=2021-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=996321, encodeId=e943996321e2, content=???, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210703/9c448fe1b3b54fd7bc9477662f4861bb/4bdadad22bfd46f2921aabb4c40265d3.jpg, createdBy=a8d81938466, createdName=weigq, createdTime=Mon Jul 05 08:38:39 CST 2021, time=2021-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1039434, encodeId=6fd61039434cf, content=机制研究离临床仍然有距离,不过与临床结合思考,仍然有帮助的,不能仅仅是纯临床思维,转化思维同样重要, beContent=null, objectType=article, channel=null, level=null, likeNumber=133, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿肿, createdTime=Mon Jul 05 07:50:56 CST 2021, time=2021-07-05, status=1, ipAttribution=)]
    2021-07-05 weigq

    ???

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=2001390, encodeId=14162001390d9, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Sat Dec 04 01:50:56 CST 2021, time=2021-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1910927, encodeId=3a53191092e82, content=<a href='/topic/show?id=04d99206316' target=_blank style='color:#2F92EE;'>#调节机制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92063, encryptionId=04d99206316, topicName=调节机制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf1b289, createdName=villahu, createdTime=Thu Sep 30 01:50:56 CST 2021, time=2021-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316274, encodeId=809b13162e410, content=<a href='/topic/show?id=654a85168c0' target=_blank style='color:#2F92EE;'>#脑震荡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85168, encryptionId=654a85168c0, topicName=脑震荡)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0041445, createdName=TZF0804, createdTime=Tue Jul 06 19:50:56 CST 2021, time=2021-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1557529, encodeId=49a7155e52923, content=<a href='/topic/show?id=7bec398e2e6' target=_blank style='color:#2F92EE;'>#哈佛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39872, encryptionId=7bec398e2e6, topicName=哈佛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c7014916331, createdName=amyloid, createdTime=Tue Jul 06 19:50:56 CST 2021, time=2021-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=996326, encodeId=daae996326c1, content=学习中, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210704/cdd1076905df433c93873ae6d3d51aef/eae5c73864694494acb8435eb7d2e9bb.jpg, createdBy=ec7b92572, createdName=lshanp, createdTime=Mon Jul 05 09:06:58 CST 2021, time=2021-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=996321, encodeId=e943996321e2, content=???, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210703/9c448fe1b3b54fd7bc9477662f4861bb/4bdadad22bfd46f2921aabb4c40265d3.jpg, createdBy=a8d81938466, createdName=weigq, createdTime=Mon Jul 05 08:38:39 CST 2021, time=2021-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1039434, encodeId=6fd61039434cf, content=机制研究离临床仍然有距离,不过与临床结合思考,仍然有帮助的,不能仅仅是纯临床思维,转化思维同样重要, beContent=null, objectType=article, channel=null, level=null, likeNumber=133, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿肿, createdTime=Mon Jul 05 07:50:56 CST 2021, time=2021-07-05, status=1, ipAttribution=)]
    2021-07-05 肿肿

    机制研究离临床仍然有距离,不过与临床结合思考,仍然有帮助的,不能仅仅是纯临床思维,转化思维同样重要

    0

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